Healthcare Provider Details

I. General information

NPI: 1770490682
Provider Name (Legal Business Name): ANTHONY GUY JOHNSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY G JOHNSON PTA

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MEDICAL CENTER DR STE 300
NEWTON KS
67114-9056
US

IV. Provider business mailing address

715 MEDICAL CENTER DR STE 300
NEWTON KS
67114-9056
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-7187
  • Fax: 316-283-4860
Mailing address:
  • Phone: 316-283-7187
  • Fax: 316-283-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04446
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: